Nivolumab-induced immune thrombocytopenia in a patient with malignant pleural mesothelioma

Area of Science:

• Oncology
• Immunology
• Hematology

Background:

• Malignant pleural mesothelioma (MPM) is a rare, aggressive thoracic malignancy.
• Nivolumab, an immune checkpoint inhibitor, has demonstrated efficacy in recurrent MPM.
• Immune-related adverse events (irAEs) are associated with nivolumab treatment and potentially better outcomes, though hematological irAEs are infrequent.

Observation:

• This report details a patient with recurrent MPM who achieved a response to nivolumab.
• The patient developed nivolumab-induced immune thrombocytopenia (ITP), a rare hematological irAE.
• Initial high-dose dexamethasone led to transient platelet recovery, necessitating re-administration for sustained normalization.

Findings:

• Nivolumab-induced ITP occurred in a patient with recurrent MPM responding to treatment.
• Management of nivolumab-induced ITP may require intensive and prolonged glucocorticoid therapy.
• This is the first reported case of nivolumab-induced ITP in MPM and its association with treatment response.

Implications:

• Hematological irAEs, such as ITP, should be considered in MPM patients receiving nivolumab.
• Close monitoring and proactive management are crucial for patients experiencing nivolumab-induced ITP.
• Understanding irAEs may provide insights into nivolumab's efficacy and patient outcomes in MPM.